JOHN DICKERSON: The president has said there will be a bloodbath in 2018 if this isn’t passed through the House and Senate. Do you agree?RYAN: I do believe that if we don’t keep our word to the people who sent us here, yes.Look, the most important thing for a person like myself, who runs for office and tells the people we are asking to hire us, this is what I will do if I get elected. And then, if you don’t do that, you are breaking your word.
Trying and failing to do what you said you would isn’t exactly “breaking your word,” but you get the point. Ryan’s main concern, at least as he expresses it here, is with the people who deeply want to see the ACA repealed: the Republican base. He and the rest of his party have been terrified of them for the past eight years, so it’s no surprise that the base’s wrath is still foremost in their minds.
But there’s a problem: 2018 is probably going to be a bloodbath for Republicans whether they pass repeal or not.
To understand why, let’s quickly run through the possible scenarios for the midterm elections as they relate to this effort, which will be the most dramatic and vividly emotional of all the legislative battles of the next few years. Ryan is almost certainly right that if they fail to pass repeal, the GOP base will be disgusted with its leaders. For eight years, Republican candidates told them, “Turn out to vote, and then as soon as we get the chance we’ll destroy this law that Barack Obama cast forth from the very fires of hell.” The base responded, delivering Republicans the House in 2010 and the Senate in 2014.
And yet, 60 or so repeal votes notwithstanding, the law remained in place. Donald Trump became the party’s presidential nominee largely because of the base’s dissatisfaction with a Republican establishment it saw as ineffectual. And now, if they can’t pass it with complete control of government, it would be even worse. You’d likely see depressed turnout among Republicans who saw no reason to rush to the polls to reelect representatives who can’t seem to do what they promised.
That’s Bloodbath Version No. 1.
Version No. 2 is just as dangerous, if not more so.
In this scenario, they pass the bill, and what everyone who knows anything about health care is predicting does indeed come true. Millions lose their coverage, out-of-pocket costs rise, premiums go up, the individual market is destabilized, and the kind of security the ACA has offered to those with preexisting conditions vanishes. Not only is the broader public angry, but Democratic voters in particular are enraged. The surge of grassroots energy we’ve seen on the left gains even more momentum. We know that what drives turnout in off-year elections is anger, and most of the anger is going to be on the left.
Not only that, the Republican base won’t be so happy about the promise that was kept once they see the results. One of the things that’s becoming increasingly clear is that the GOP reform bill is going to hit many of their key constituencies especially hard. The bill allows insurance companies to charge older patients more, while giving them a tax credit that in many cases will be worth far less than the ACA subsidies they’re getting now. Working-class voters will find it harder to afford insurance. The suffering will be particularly acute in rural areas.
The president’s party almost always loses seats in Congress in midterm elections. That’s the baseline from which Republicans start. Add in a catastrophic rollout of their repeal, and it could get much worse.
There is one scenario in which Republicans can avoid a bloodbath. That’s if they pass repeal and it turns out to be as great as they claim, despite what everyone else says. More people get coverage, costs come down, premiums plummet, and the free market delivers us to the paradise we’ve been waiting for.
If there’s anyone, even Republicans, who sincerely thinks that’s going to happen, I’d be shocked. Even Paul Ryan is preparing for millions to lose coverage; his unique spin on that possibility is that when they do, it’ll actually be a sign of success. Here’s another exchange he had with John Dickerson:
DICKERSON: How many people are going to lose coverage under this new —RYAN: I can’t answer that question. It’s up to people. Here — here’s the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country. So the question is, are we providing a system where people have access to health insurance if they choose to do so? And the answer is yes.
Unlike some Republicans, Ryan isn’t promising that no one will lose their coverage. He’s saying that when they do, it will only be because they chose to go without it, once they were led into the glorious light of liberty. As he put it, “You get it if you want it. That’s freedom.” And if you want it but you can’t afford it? Hey, freedom isn’t free.
There’s a theory going around that Republicans actually want their bill to fail, so they can avoid the disaster that will come with implementing it and just move on to cutting taxes, which is their top priority anyway. I can’t say if that’s what they’re thinking, but they may come to realize that while the scenario in which they fail to repeal the ACA could produce a bad result in 2018, the real bloodbath will come if they succeed.